LHH1996

I need advice on how to transition from working in a SNF for 13 years to a new career in a hospital. My first 7 years was in a ECF that was attached to a hospital and we would get pulled all over the hospital. So i have some experience on other units. the ECF was also much higher skill level back then than the SNF i have worked at since. As much as i enjoyed working in long term care, i feel i am burned out with this type. i currently work as an MDS Coordinator. i pick up extra hours as floor nurse and supervisor often. when i do those things it reminds me that i miss the more hands on patient care. i am just not sure how to approach them at the hospital level to let them know that i am serious about wanting a change in career and that i really want them to give me a chance. anyone who has done this or has advice please let me know!

i may seem alittle off base...but who cares what they wear!...i know some veterinarian staff (who aren't nurses obviously) that wear scrubs...so when they go out in public does that mean they are confusing people? When i am out and about i don't pay attention to other peoples clothes.

don't let that stupid doctor stop you from helping out your fellow nurses they do appreciate you! ....besides..nurses are smarter than doctors anyway...LOL

when i worked at a SNF attached to the hospital, it was a much higher acuity. There was no sending patients to the ER for uti, blood, etc etc. When someone coded we did it,when someone needed life flighted we did it, there was a wider age range of patients. Also the doctors often came in more often. ( In longterm care regulation, it is initially and atleast every 30days). If the resident needs a certain procedure it was often done at the bedside if able by the doctor with RN assist, Post -op patients came to us sooner...Later, they did change some things for "cost saving" reasons..like giving blood..but we still could do iv's etc.. (alot goes into how a SNF gets paid what procedures "cost too much" to do onsite.. But anyway..now i work at a free standing SNF and it is much more "boring" in the sense of what i was used to do prior.. as far as staffing..there are regulations to follow. and most SNF's will stick with staffing for acuity when needed otherwise doing just above what is regulated.

that is what i was trying to relate to in another post when i said that "health care is messed up" (about going to ER for non-emergancies)..at least you understand what i meant...people who go to the ER usually have a copay but testing etc is covered in many cases in relation to the ER . if you go to the PCP..not only is there a visit copay , but lab work copay or pay out of pocket, or xrays or other testing that people can't afford to pay for. so they either avoid going until they can't take it anymore..etc etc...

the F-tag (LTC regs) manual explains that well..plus check your facility's policy. depending, there are lots of things that can be considered a restraint in ltc. so it would help to know what kind you are talking about and the reason for it. otherwise it is to only be very last resort, there has to be a trial of other attempts to not use restraint, then you get the physician order, consent signed by family/ or POA ..all of this is of course is reviewed with your interdiciplinary team, then you have to make sure the resident is removed from the restraint, offered activites, offered bathroom, offered hydration etc at least every two hours, then in long term care the restraint really doesn't have to be reviewed or have updated orders quarterly and as needed. as needed means, always look for opportunity to remove it if not needed, if there is a change in condition, etc. there are usually assessments that need done initially and quarterly and you have to prove you have tried attempts to d/c the restraint or not use it at all. it really is a complicated issue especially if you are used to hospitals who have a more liberal restraint use policy...definetly look at the LTC regs, go to cms.gov that may help too... hope this helps?

i heard today that one of the hospital here is down 150 beds...

last time i called off was for a horrible toothache in January 2008..i actually went to work that day , but left because i couldn't take it anymore..the DON counted it as a call off...

try not to beat yourself up! i know it was upsetting at the time, but we all have done something at one time or another. the fact that you cared shows that you are compassionate about what you do. Hang in there! you are still an awesome nurse!

oh..dear...i would hate for you to give up a career that can be rewarding even if it doesn't seem that way. i realize you are frustrated but don't give up. REally! as an earlier post said, get help for the attention problems. you haven't been doing it that long. try to hang in there? HUGS!!!!

one of my nursing instructors i had, i also thought was a nightmare until i realized she really truly prepared me better than i ever imagined..

We always have had Np's "come" to the facility also..i think the question was for the SNF to actually "employ" a NP...

ok..thanks. still don't see what that has to do with anything though..lol

oh my goodness flightnurse2b...i am so sorry you had to go through that...."Hugs"

i feel completely stupid, but i don't know what "lip gloss poppin means"?